101
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Del Rey Hurtado de Mendoza B, Sánchez-de-Toledo J, Bobillo Perez S, Girona M, Balaguer Gargallo M, Rodríguez-Fanjul J. Lung Ultrasound to Assess the Etiology of Persistent Pulmonary Hypertension of the Newborn (LUPPHYN Study): A Pilot Study. Neonatology 2019; 116:140-146. [PMID: 31096216 DOI: 10.1159/000499047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Persistent pulmonary hypertension of the newborn (PPHN) is a neonatal syndrome associated with significant morbidity and mortality that is caused by the failure of postnatal drop in pulmonary vascular resistance. In extreme cases, patients may require extracorporeal membrane oxygenation therapy (ECMO). The aim of this study was to explore lung ultrasound (LUS) patterns in newborns with PPHN requiring ECMO. PATIENTS AND METHODS From January 2014 to January 2018, LUS was performed on patients with PPHN admitted for ECMO treatment. PPHN diagnosis was based on clinical and echocardiographic findings. LUS was performed before patients underwent ECMO cannulation. An underlying diagnosis was made taking into account the patient's complete medical history, excluding LUS information. A blinded physician, unaware of the patient's clinical condition, analyzed the stored ultrasound images. Results were then compared with chest x-ray (CXR) diagnoses. RESULTS Seventeen patients were recruited; 12 were male (70.6%). The median gestational age was 38.7 weeks, with 13 term newborns (76.5%). Twelve were cannulated for VA ECMO, with a median ECMO run of 111.2 h. Six patients (35%) survived. Patients with alveolar capillary dysplasia with misaligned pulmonary veins, fetal ductus arteriosus constriction, or sepsis had normal LUS patterns (A-lines with lung sliding). LUS showed a better sensitivity (88.9%) and specificity (85%) than CXR (55.6 and 77.5%, respectively) in identifying patients with nonparenchymal lung disease. CONCLUSIONS LUS can provide essential information to help diagnose the underlying cause of PPHN in an earlier and more effective way than CXR. LUS is suitable for routine utilization in the intensive care unit.
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Affiliation(s)
| | - Joan Sánchez-de-Toledo
- Cardiology Department, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain.,Critical Care Medicine Department, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sara Bobillo Perez
- Pediatric Intensive Care Unit, Institut Recerca Hospital Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Mónica Girona
- Pediatric Service Transport, Servei Emergències Mèdiques (SEM), Hospital Sant Joan de Déu and University of Barcelona, Barcelona, Spain.,Pediatric Intensive Care Unit, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain
| | - Mónica Balaguer Gargallo
- Pediatric Intensive Care Unit, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Barcelona, Spain
| | - Javier Rodríguez-Fanjul
- Pediatric Service Transport, Servei Emergències Mèdiques (SEM), Hospital Sant Joan de Déu and University of Barcelona, Barcelona, Spain, .,Pediatric Intensive Care Unit, Pediatric Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain,
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102
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Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine: Results of a National Survey. Pediatr Crit Care Med 2018; 19:e561-e568. [PMID: 30113518 DOI: 10.1097/pcc.0000000000001692] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess current diagnostic bedside ultrasound program core element (training, credentialing, image storage, documentation, and quality assurance) implementation across pediatric critical care medicine divisions in the United States. DESIGN Cross-sectional questionnaire-based needs assessment survey. SETTING Pediatric critical care medicine divisions with an Accreditation Council of Graduate Medical Education-accredited fellowship. RESPONDENTS Divisional leaders in education and/or bedside ultrasound training. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Fifty-five of 67 pediatric critical care medicine divisions (82%) with an Accreditation Council of Graduate Medical Education-accredited fellowship provided responses. Overall, 63% of responding divisions (34/54) were clinically performing diagnostic bedside ultrasound studies with no difference between divisions with large versus small units. Diagnostic bedside ultrasound training is available for pediatric critical care medicine fellows within 67% of divisions (35/52) with no difference in availability between divisions with large versus small units. Other core elements were present in less than 25% of all divisions performing clinical studies, with a statistically significant increase in credentialing and documentation among divisions with large units (p = 0.048 and 0.01, respectively). All core elements were perceived to have not only high impact in program development but also high effort in implementation. Assuming that all structural elements could be effectively implemented within their division, 83% of respondents (43/52) agreed that diagnostic bedside ultrasound should be a core curricular component of fellowship education. CONCLUSIONS Diagnostic bedside ultrasound is increasingly prevalent in training and clinical use across the pediatric critical care medicine landscape despite frequently absent core programmatic infrastructural elements. These core elements are perceived as important to program development, regardless of division unit size. Shared standardized resources may assist in reducing the effort in core element implementation and allow us to measure important educational and clinical outcomes.
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103
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Bonasso PC, Dassinger MS, Wyrick DL, Gurien LA, Burford JM, Smith SD. Review of bedside surgeon-performed ultrasound in pediatric patients. J Pediatr Surg 2018; 53:2279-2289. [PMID: 29807830 DOI: 10.1016/j.jpedsurg.2018.04.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/21/2018] [Accepted: 04/28/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Pediatric surgeon performed bedside ultrasound (PSPBUS) is a targeted examination that is diagnostic or therapeutic. The aim of this paper is to review literature involving PSPBUS. METHODS PSPBUS practices reviewed in this paper include central venous catheter placement, physiologic assessment (volume status and echocardiography), hypertrophic pyloric stenosis diagnosis, appendicitis diagnosis, the Focused Assessment with Sonography for Trauma (FAST), thoracic evaluation, and soft tissue infection evaluation. RESULTS There are no standards for the practice of PSPBUS. CONCLUSIONS As the role of the pediatric surgeon continues to evolve, PSPBUS will influence practice patterns, disease diagnosis, and patient management. TYPE OF STUDY Review Article. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Patrick C Bonasso
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202.
| | - Melvin S Dassinger
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202
| | - Deidre L Wyrick
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202
| | - Lori A Gurien
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202
| | - Jeffrey M Burford
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202
| | - Samuel D Smith
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR 72202
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104
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Raimondi F, Migliaro F, Verdoliva L, Gragnaniello D, Poggi G, Kosova R, Sansone C, Vallone G, Capasso L. Visual assessment versus computer-assisted gray scale analysis in the ultrasound evaluation of neonatal respiratory status. PLoS One 2018; 13:e0202397. [PMID: 30335753 PMCID: PMC6193620 DOI: 10.1371/journal.pone.0202397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 08/02/2018] [Indexed: 12/15/2022] Open
Abstract
Background and aim Lung ultrasound has been used to describe common respiratory diseases both by visual and computer-assisted gray scale analysis. In the present paper, we compare both methods in assessing neonatal respiratory status keeping two oxygenation indexes as standards. Patients and methods Neonates admitted to the NICU for respiratory distress were enrolled. Two neonatologists not attending the patients performed a lung scan, built a single frame database and rated the images with a standardized score. The same dataset was processed using the gray scale analysis implemented with textural features and machine learning analysis. Both the oxygenation ratio (PaO2/FiO2) and the alveolar arterial oxygen gradient (A-a) were kept as reference standards. Results Seventy-five neonates with different respiratory status were enrolled in the study and a dataset of 600 ultrasound frames was built. Visual assessment of respiratory status correlated significantly with PaO2/FiO2 (r = -0.55; p<0.0001) and the A-a (r = 0.59; p<0.0001) with a strong interobserver agreement (K = 0.91). A significant correlation was also found between both oxygenation indexes and the gray scale analysis of lung ultrasound scans using regions of interest corresponding to 50K (r = -0.42; p<0.002 for PaO2/FiO2; r = 0.46 p<0.001 for A-a) and 100K (r = -0.35 p<0.01 for PaO2/FiO2; r = 0.58 p<0.0001 for A-a) pixels regions of interest. Conclusions A semi quantitative estimate of the degree of neonatal respiratory distress was demonstrated both by a validated scoring system and by computer assisted analysis of the ultrasound scan. This data may help to implement point of care ultrasound diagnostics in the NICU.
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Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università “Federico II”, Naples, Italy
- * E-mail:
| | - Fiorella Migliaro
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università “Federico II”, Naples, Italy
| | - Luisa Verdoliva
- Department of Electrical Engineering and Information Technology, Università “Federico II”, Naples, Italy
| | - Diego Gragnaniello
- Department of Electrical Engineering and Information Technology, Università “Federico II”, Naples, Italy
| | - Giovanni Poggi
- Department of Electrical Engineering and Information Technology, Università “Federico II”, Naples, Italy
| | - Roberta Kosova
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università “Federico II”, Naples, Italy
| | - Carlo Sansone
- Department of Electrical Engineering and Information Technology, Università “Federico II”, Naples, Italy
| | - Gianfranco Vallone
- Department of Advanced Biomedical Sciences, Università “Federico II”, Naples, Italy
| | - Letizia Capasso
- Division of Neonatology, Section of Pediatrics, Department of Translational Medical Sciences, Università “Federico II”, Naples, Italy
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105
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Diana P, Zampieri D, Furlani E, Pivetta E, Calabrese F, Pezzuto F, Marulli G, Rea F, Ori C, Persona P. Lung ultrasound as a monitoring tool in lung transplantation in rodents: a feasibility study. J Thorac Dis 2018; 10:4274-4282. [PMID: 30174873 DOI: 10.21037/jtd.2018.06.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Orthotopic lung transplantation in rats has been developed as a model to study organ dysfunction, but available tools for monitoring the graft function are limited. In this study, lung ultrasound (LUS) is proposed as a new non-invasive monitoring tool in awake rodents. Methods LUS was applied to native and graft lung of six rats after left orthotopic transplantation. Rats were monitored with LUS while awake, patterns identified, images evaluated with a scoring system, intra- and inter-rater agreement was assessed and examination times analyzed. Results A total of 78 clips were recorded. The median quality score of LUS was 3.66/4 for left hemithorax and 3.71/4 for native right side. The intra-rater agreement was 0.53 and 0.65 and the inter-rater agreement was 0.61 (P<0.01). Median time to complete the examination was 233.0 seconds (IQR 142) for both lungs, lowered from 254.0 seconds (IQR 129.5) (first trimester of study) to 205.5 seconds (IQR 88.5) (second trimester of the study). Significant findings on LUS were confirmed on pathological examination. Conclusions LUS in awake rodents without shaving has been shown to be both feasible and safe and the images collected were of good quality and comparable to those obtained in anesthetized rats without bristles.
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Affiliation(s)
- Paolo Diana
- Department of Medicine, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Davide Zampieri
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.,Department of Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisa Furlani
- Department of Medicine, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Emanuele Pivetta
- Department of Medical Sciences, University of Turin, Torino, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federica Pezzuto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giuseppe Marulli
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Federico Rea
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Carlo Ori
- Department of Medicine, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paolo Persona
- Department of Emergency, Azienda Ospedaliera di Padova, Padova, Italy
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106
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What’s new in lung ultrasound in the critically ill or injured child. Intensive Care Med 2018; 45:508-511. [DOI: 10.1007/s00134-018-5356-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 08/25/2018] [Indexed: 01/04/2023]
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107
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Fraga MV, Stoller JZ, Lorch SA. Novel Technologies for Neonatal Care: The Case of Point-of-Care Lung Ultrasonography. Pediatrics 2018; 142:peds.2018-1621. [PMID: 30108143 DOI: 10.1542/peds.2018-1621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- María V Fraga
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Z Stoller
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott A Lorch
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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108
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Perri A, Riccardi R, Iannotta R, Di Molfetta DV, Arena R, Vento G, Zecca E. Lung ultrasonography score versus chest X-ray score to predict surfactant administration in newborns with respiratory distress syndrome. Pediatr Pulmonol 2018; 53:1231-1236. [PMID: 29870158 DOI: 10.1002/ppul.24076] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/16/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We aim to verify the diagnostic accuracy of a lung ultrasonography (LUS) score to early predict the need for surfactant therapy in newborns with respiratory distress syndrome (RDS), and to compare it with a chest X-ray score. METHODS In this prospective diagnostic accuracy study we included all newborns admitted for respiratory distress and initially treated with nasal CPAP. LUS was performed within 2 h from nasal CPAP positioning and in any case before surfactant administration. A chest X-ray was also performed. A LUS score and an X-ray score were used and compared. Ability of the scores to predict surfactant administration was evaluated through ROC analysis. RESULTS In our population of 56 newborns with mean gestational age of 31 weeks (SD 3) and mean birth weight of 1442 g (SD 520), LUS score showed higher AUC than X-ray score in early recognition of infants with respiratory distress syndrome requiring surfactant treatment (0.94; 95%CI, 0.89-0.98; P < 0.001 vs 0.80; 95%CI, 0.74-0.86; P < 0.001). It showed also higher sensitivity (86% vs 82%), higher specificity (88% vs 76%), better positive (83% vs 69%), and negative (91% vs 87%) predictive values. CONCLUSIONS LUS is a non-invasive, bedside and reproducible method that could improve the management of neonatal respiratory distress. It is accurate and reliable to early identify patients who will need treatment with surfactant allowing both an early treatment and a reduction of radiation exposure.
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Affiliation(s)
- Alessandro Perri
- Department of Neonatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Riccardi
- Department of Neonatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Rossella Iannotta
- Department of Neonatology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Roberta Arena
- Department of Neonatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Vento
- Department of Neonatology, Catholic University of the Sacred Heart, Rome, Italy
| | - Enrico Zecca
- Department of Neonatology, Catholic University of the Sacred Heart, Rome, Italy
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109
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Dominguez A, Gaspar HA, Preto M, Ejzenberg FE. Point-of-care lung ultrasound in paediatric critical and emergency care. J Paediatr Child Health 2018; 54:945-952. [PMID: 29851160 DOI: 10.1111/jpc.14067] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 04/02/2018] [Accepted: 04/10/2018] [Indexed: 11/27/2022]
Abstract
Ultrasound techniques have been developed since the past century and are becoming more useful in different areas of medical knowledge. More recently, lung ultrasound gained importance throughout artefacts analysis to help clinical evaluation at bedside and became subject of interest in the paediatric intensive care and emergency department settings for both procedural and diagnostic purposes. The normal pattern of lung ultrasound is defined by the presence of lung sliding associated with A-lines whereas B-lines may be representative of pathologic findings. This review focuses on some of the most common pulmonary conditions, their respective sonographic features and clinical implications in the emergency department and paediatric intensive care unit.
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Affiliation(s)
- Anna Dominguez
- Pediatric Intensive Care Unit, Children's Institute University of Sao Paulo School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Heloisa A Gaspar
- Pediatric Intensive Care Unit, Albert Einstein Hospital, São Paulo, Brazil
| | - Marcela Preto
- Emergency Department, Children's Institute University of Sao Paulo School of Medicine, University of São Paulo, São Paulo, Brazil
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110
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Murphy MC, Heiring C, Doglioni N, Trevisanuto D, Blennow M, Bohlin K, Lista G, Stucchi I, O’Donnell CPF. Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns: A Randomized Clinical Trial. JAMA Pediatr 2018; 172:664-669. [PMID: 29799982 PMCID: PMC6137515 DOI: 10.1001/jamapediatrics.2018.0623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. OBJECTIVE To investigate whether treating pneumothoraces diagnosed on chest radiography (CR) in newborns receiving respiratory support with NA results in fewer infants having CDs inserted within 6 hours of diagnosis. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from October 7, 2013, to December 21, 2016. The setting was 5 tertiary European neonatal intensive care units. Infants receiving respiratory support (endotracheal ventilation, continuous positive airway pressure, or supplemental oxygen >40%) who had a pneumothorax on CR that clinicians deemed needed treatment were eligible for inclusion. INTERVENTIONS Infants were randomly assigned (1:1) to drainage using NA or CD insertion, stratified by center and gestation at birth (<32 vs ≥32 weeks). Caregivers were not masked to group assignment. For NA, a needle was inserted between the ribs to aspirate air and was removed once air was no longer aspirated. A CD was inserted if clinicians deemed that the response was inadequate. For CD insertion, a drain was inserted between the ribs and was left in situ. MAIN OUTCOMES AND MEASURES The primary outcome was whether a CD was inserted on the side of the pneumothorax within 6 hours of diagnosis. RESULTS A total of 76 infants were randomly assigned, and 6 (4 assigned to NA and 2 to CD) were excluded because they met exclusion criteria at enrollment. Of the 70 remaining infants, 33 (16 male [48%]) were assigned to NA and 37 (22 male [59%]) to CD insertion. Their median (interquartile range [IQR]) gestational age was 31 (27-38) vs 31 (27-35) weeks, and their median (IQR) birth weight was 1385 (1110-3365) vs 1690 (1060-2025) g, respectively. Fewer infants assigned to NA had a CD inserted within 6 hours (55% [18 of 33] vs 100% [37 of 37]; relative risk, 0.55; 95% CI, 0.40-0.75) and during hospitalization (70% [23 of 33] vs 100% [37 of 37]; relative risk, 0.70, 95% CI, 0.56-0.87). CONCLUSIONS AND RELEVANCE Needle aspiration reduced the rate of CD insertion in symptomatic newborns with pneumothorax on CR. It should be used as the initial method of draining radiologically confirmed pneumothorax in symptomatic infants. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN65161530.
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Affiliation(s)
- Madeleine C. Murphy
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland,National Children’s Research Centre, Dublin, Ireland
| | | | - Nicoletta Doglioni
- Department of Women’s and Children’s Health, Azienda Ospedaliera di Padova, University of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Department of Women’s and Children’s Health, Azienda Ospedaliera di Padova, University of Padova, Padova, Italy
| | - Mats Blennow
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | - Kajsa Bohlin
- Karolinska Institutet, University Hospital, Stockholm, Sweden
| | - Gianluca Lista
- Department of Neonatology, Ospedale dei Bambini “Vittore Buzzi,” Milano, Italy
| | - Ilaria Stucchi
- Department of Neonatology, Ospedale dei Bambini “Vittore Buzzi,” Milano, Italy
| | - Colm P. F. O’Donnell
- Department of Neonatology, National Maternity Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland,National Children’s Research Centre, Dublin, Ireland
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111
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Abstract
PURPOSE OF REVIEW The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research. RECENT FINDINGS POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration. Rapidly evolving and upcoming applications include diagnosis of pneumonia and acute chest syndrome, identification of intra-abdominal injury via contrast-enhancement, guidance of resuscitation, monitoring of increased intracranial pressure and procedural guidance. SUMMARY POCUS is an effective and burgeoning method for both rapid diagnostics and guidance for interventions and procedures. It has clinical application for a variety of conditions that span PEM and PICU settings. Formal POCUS training is needed to standardize and expand use of this valuable technology by PICU and PEM providers alike.
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112
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Liang HY, Liang XW, Chen ZY, Tan XH, Yang HH, Liao JY, Cai K, Yu JS. Ultrasound in neonatal lung disease. Quant Imaging Med Surg 2018; 8:535-546. [PMID: 30050788 DOI: 10.21037/qims.2018.06.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Lung diseases in neonates can be life-threatening condition and may result in respiratory failure and death. Chest X-ray is a traditional diagnostic technique that results in radiation exposure to patients. Lung ultrasound is a user-friendly imaging technique that has been increasingly used in clinical practice in recent years and presents the advantages of real-time imaging and without radiation. Here we review the sonographic appearances of common neonatal lung diseases and present demonstration of typical cases.
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Affiliation(s)
- Hui-Ying Liang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Xiao-Wen Liang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Zhi-Yi Chen
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Xiao-Hua Tan
- Department of Neonatology and Neonatal Intensive Care Unit, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Hui-Hui Yang
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Jian-Yi Liao
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Kuan Cai
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Jin-Sui Yu
- Department of Ultrasound Medicine, Laboratory of Ultrasound Molecular Imaging, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
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113
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Noteworthy Professional News. Adv Neonatal Care 2018. [DOI: 10.1097/anc.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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114
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Blank DA, Kamlin COF, Rogerson SR, Fox LM, Lorenz L, Kane SC, Polglase GR, Hooper SB, Davis PG. Lung ultrasound immediately after birth to describe normal neonatal transition: an observational study. Arch Dis Child Fetal Neonatal Ed 2018; 103:F157-F162. [PMID: 28659360 DOI: 10.1136/archdischild-2017-312818] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/03/2017] [Accepted: 05/23/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Lung ultrasound (LUS) has shown promise as a diagnostic tool for the evaluation of the newborn with respiratory distress. No study has described LUS during 'normal' transition. Our goal was to characterise the appearance of serial LUS in healthy newborns from the first minutes after birth until airway liquid clearance is achieved. STUDY DESIGN Prospective observational study. SETTING Single-centre tertiary perinatal centre in Australia. PATIENTS Of 115 infants born at ≥35 weeks gestational age, mean (SD) gestational age of 386/7 weeks±11 days, mean birth weight of 3380±555 g, 51 were delivered vaginally, 14 via caesarean section (CS) after labour and 50 infants via elective CS. INTERVENTIONS We obtained serial LUS videos via the right and left axillae at 1-10 min, 11-20 min and 1, 2, 4 and 24 hours after birth. MAIN OUTCOME MEASURES LUS videos were graded for aeration and liquid clearance according to a previously validated system. RESULTS We analysed 1168 LUS video recordings. As assessed by LUS, lung aeration and airway liquid clearance occurred quickly. All infants had an established pleural line at the first examination (median=2 (1-4) min). Only 14% of infants had substantial liquid retention at 10 min after birth. 49%, 78% and 100% of infants had completed airway liquid clearance at 2, 4 and 24 hours, respectively. CONCLUSIONS In healthy transitioning newborn infants, lung aeration and partial liquid clearance are achieved on the first minutes after birth with complete liquid clearance typically achieved within the first 4 hours of birth. TRIAL REGISTRATION NUMBER ANZCT 12615000380594.
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Affiliation(s)
- Douglas A Blank
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - C Omar Farouk Kamlin
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Lisa M Fox
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Laila Lorenz
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia.,Department of Neonatology, University Children's Hospital of Tübingen, Tübingen, Germany
| | - Stefan Charles Kane
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia.,Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Victoria, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
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115
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Ren XL, Fu W, Liu J, Liu Y, Xia RM. Lung ultrasonography to diagnose pulmonary hemorrhage of the newborn. J Matern Fetal Neonatal Med 2017; 30:2601-2606. [PMID: 27809611 DOI: 10.1080/14767058.2016.1256997] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study was aimed to investigate the application of lung ultrasound for the diagnosis of pulmonary hemorrhage of the newborn (PHN). METHODS From July 2013 to June 2016, 157 neonates were enrolled in the study. They were divided into two groups: a study group of 57 neonates, who were diagnosed with PHN according to their medical history, clinical manifestations and chest X-ray findings, and a control group of 100 neonates with no lung disease. All subjects underwent bedside lung ultrasound in a quiet state in a supine, lateral or prone position, performed by a single expert physician. The ultrasound findings were compared between the two groups. RESULTS The lung ultrasound main findings associated with PHN included lung consolidation with air bronchograms with an incidence of 82.5%, a shred sign with an incidence of 91.2%, pleural effusion with an incidence of 84.2% (pleurocentesis confirmed the fluid was really bleeding), atelectasis with a incidence of 33.3%, pleural line abnormalities, as well as disappearing A-lines with an incidence of 100%, and 11.9% of these patients had the main manifestations of alveolar-interstitial syndrome (AIS). The shred sign exhibited a sensitivity of 91.2% and a specificity of 100% in diagnosing PHN. CONCLUSIONS Lung ultrasonography is useful and reliable for diagnosing PHN, which is suitable for routine application in the neonatal intensive care unit.
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Affiliation(s)
- Xiao-Ling Ren
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
- b Department of Neonatology and NICU of Bayi Children's Hospital , the Army General Hospital of the Chinese PLA , Beijing , China
| | - Wei Fu
- b Department of Neonatology and NICU of Bayi Children's Hospital , the Army General Hospital of the Chinese PLA , Beijing , China
| | - Jing Liu
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
- b Department of Neonatology and NICU of Bayi Children's Hospital , the Army General Hospital of the Chinese PLA , Beijing , China
| | - Ying Liu
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
| | - Rong-Ming Xia
- a Department of Neonatology and NICU , Beijing Chaoyang District Maternal and Child Health Care Hospital , Beijing , China and
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116
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Nguyen J. Call for point-of-care ultrasound training regimens in neonatal-perinatal medicine. J Pediatr 2017; 185:254. [PMID: 28279432 DOI: 10.1016/j.jpeds.2017.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Jimmy Nguyen
- Division of Neonatal-Perinatal Medicine Department of Pediatrics LAC+USC Medical Center Keck School of Medicine; Center for Fetal and Neonatal Medicine Division of Neonatal-Perinatal Medicine Children's Hospital Los Angeles University of Southern California Los Angeles, California
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117
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Blank DA, Rogerson SR, Kamlin COF, Fox LM, Lorenz L, Kane SC, Polglase GR, Hooper SB, Davis PG. Lung ultrasound during the initiation of breathing in healthy term and late preterm infants immediately after birth, a prospective, observational study. Resuscitation 2017; 114:59-65. [PMID: 28249708 DOI: 10.1016/j.resuscitation.2017.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/03/2017] [Accepted: 02/17/2017] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Lung ultrasound (LUS) has shown promise for evaluation of newborns with respiratory distress. However, no study has described the appearance of LUS during the initiation of breathing. We used LUS to describe the appearance of the lungs in healthy infants immediately after birth, starting with the infant's first breath, through the first 20min after birth. METHODS This was a single-center observational study enrolling neonates born at ≥35 weeks. We obtained LUS video recordings with the initiation of breathing. Recordings that captured one of the 1st four breaths after birth were included. We also obtained recordings at 1-10 and 11-20min after birth. Recordings were graded using a modified version of a previously published system, with additional grades to describe the appearance of the lungs prior to establishment of the pleural line. RESULTS We studied 63 infants, mean gestational age=391/7±2 days, mean weight=3473g±422, 33 infants were delivered vaginally and 30 via cesarean section. We captured the first breath after birth in 28 infants and within the first four breaths from the remaining 35 infants. The pleural line was established by a median of 4 breaths (3-6). At the 1-10min examination, all infants had an established pleural line and 89% demonstrated substantial liquid clearance. At the 11-20min examination, all infants had substantial liquid clearance. CONCLUSION Establishment of the pleural line, indicating lung aeration and substantial liquid clearance is achieved with the first few breaths after birth in term and near term infants.
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Affiliation(s)
- Douglas A Blank
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia.
| | - Sheryle R Rogerson
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - C Omar F Kamlin
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - Lisa M Fox
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - Laila Lorenz
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; Department of Neonatology, University Children's Hospital of Tübingen, Germany
| | - Stefan C Kane
- The University of Melbourne, Department of Obstetrics and Gynecology, Melbourne, Australia; Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Australia
| | - Graeme R Polglase
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Stuart B Hooper
- The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia
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118
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Raimondi F, Migliaro F, Capasso L. Lung Ultrasound Diagnosis of Pneumothorax and Intervention: The Fundamental Role of Clinical Data. J Emerg Med 2017; 52:242. [PMID: 27712898 DOI: 10.1016/j.jemermed.2016.07.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/25/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II", Napoli, Italy
| | - Fiorella Migliaro
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II", Napoli, Italy
| | - Letizia Capasso
- Division of Neonatology, Department of Translational Medical Sciences, Università "Federico II", Napoli, Italy
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119
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Trovato G, Sperandeo M. Reply to Raimondi et al. J Emerg Med 2017; 52:242-243. [PMID: 27720285 DOI: 10.1016/j.jemermed.2016.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/17/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Guglielmo Trovato
- Department of Clinical and Experimental Medicine, The Postgraduate School of Clinical Ultrasound, The Policlinico Hospital of the University of Catania, Catania, Italy
| | - Marco Sperandeo
- Department of Internal Medicine, Diagnostic and Interventional Ultrasound Unit, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
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Marin JR, Abo AM, Arroyo AC, Doniger SJ, Fischer JW, Rempell R, Gary B, Holmes JF, Kessler DO, Lam SHF, Levine MC, Levy JA, Murray A, Ng L, Noble VE, Ramirez-Schrempp D, Riley DC, Saul T, Shah V, Sivitz AB, Tay ET, Teng D, Chaudoin L, Tsung JW, Vieira RL, Vitberg YM, Lewiss RE. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J 2016; 8:16. [PMID: 27812885 PMCID: PMC5095098 DOI: 10.1186/s13089-016-0049-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/01/2016] [Indexed: 12/19/2022] Open
Abstract
The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed "how to" and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.
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Affiliation(s)
- Jennifer R. Marin
- Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA
| | - Alyssa M. Abo
- Children’s National Medical Center, Washington DC, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Lorraine Ng
- Morgan Stanley Children’s Hospital, New York, NY USA
| | | | | | | | | | | | | | | | - David Teng
- Cohen Children’s Medical Center, New Hyde Park, USA
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